Prostate radiation therapy today uses two main approaches: brachytherapy (internal seeds or temporary HDR implants) and external beam radiation (IMRT, IGRT, SBRT, proton). Planning now integrates TRUS with MRI/CT. Brachytherapy suits many low- and some intermediate-risk cases; EBRT (sometimes with ADT) treats more extensive or higher-risk disease. Newer fractionation schedules shorten treatment; common side effects include urinary, bowel, and sexual changes. Long-term control varies by stage and risk .

Two main radiation approaches

Radiation therapy for prostate cancer now falls into two broad categories: brachytherapy (internal) and external beam radiation therapy (EBRT). Choice depends on cancer stage, prostate size, prior surgeries, and patient preference.

Brachytherapy (internal seed implants)

Brachytherapy places radioactive material directly into the prostate. Low-dose-rate (LDR) "seed" implants (commonly iodine-125 or palladium-103) leave tiny radioactive seeds in place to deliver dose over several months. High-dose-rate (HDR) brachytherapy uses a temporary source (for example, iridium-192) placed into the gland for minutes to hours during each treatment session.

Modern planning combines transrectal ultrasound (TRUS) with MRI or CT to map the gland, calculate volume, and plan seed placement. Many men with low- or favorable intermediate-risk, organ-confined tumors are good candidates for LDR brachytherapy. HDR brachytherapy is often used with EBRT for higher-risk disease.

Brachytherapy is usually outpatient. LDR implant procedures typically take under an hour. Recovery is fast for most men; many resume normal activities within a day or two. Common side effects include urinary urgency, frequency, and erectile changes; longer-term urinary or sexual complications occur in a minority of patients.

External beam radiation therapy (EBRT)

EBRT delivers high-energy x-rays or particle beams from outside the body. Advances such as intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), volumetric arc therapy (VMAT), and proton therapy improve dose targeting and reduce exposure to surrounding tissues.

Treatment schedules have shortened compared with older regimens. Traditional courses lasted 7-9 weeks; many centers now offer moderate hypofractionation (about 4-6 weeks) or stereotactic body radiotherapy (SBRT), which can be delivered in about five sessions for selected patients.

EBRT suits men with tumors that extend beyond the gland or those with higher-risk features. Physicians often combine EBRT with androgen-deprivation therapy (ADT) for intermediate- and high-risk disease.

Side effects include urinary irritation, bowel symptoms (diarrhea, rectal discomfort), and erectile dysfunction. Contemporary imaging and planning aim to minimize these effects, and many side effects improve over months to years.

Outcomes and decision factors

Long-term cancer control is generally good for localized prostate cancer, but outcomes vary by stage and risk group . Treatment choice balances disease features, side-effect profiles, prostate anatomy, prior surgeries, and patient priorities. Discuss modern planning techniques (MRI fusion, IGRT), fractionation options (conventional, hypofractionation, SBRT), and brachytherapy types (LDR vs HDR) with your radiation oncologist to decide the best approach for you.
  1. Confirm current 10-year cancer-control and survival statistics by stage and risk group for prostate cancer (e.g., SEER or recent pooled analyses).

FAQs about Radiation Therapy

What is the difference between LDR and HDR brachytherapy?
LDR brachytherapy leaves small radioactive seeds in the prostate that deliver dose over several months. HDR brachytherapy uses a temporary, high-activity source placed into the prostate for short sessions; the source is removed after each treatment.
How long does external beam radiation take today?
Traditional EBRT lasted 7-9 weeks, but many centers now offer moderate hypofractionation (about 4-6 weeks) or SBRT, which can be delivered in about five sessions for selected patients.
Who is a good candidate for brachytherapy?
Men with low- or favorable intermediate-risk, organ-confined prostate cancer and suitable prostate anatomy are often good candidates for LDR brachytherapy; HDR may be used for higher-risk cases, sometimes with EBRT.
What are the common side effects of prostate radiation?
Common side effects include urinary urgency and frequency, bowel symptoms (diarrhea or rectal discomfort), and erectile dysfunction. Most early symptoms improve over months; a minority of patients have longer-term problems.

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